LENT score - useful clinical tool?

Background: Malignant pleural effusions (MPE) are very common and infer a poor prognosis, with a median survival of 3-12 months. The pleural intervention chosen to manage symptomatic MPE is determined by the clinician involved, patient preferences and services available. The LENT score is a validated tool to help predict mortality in those with MPE. Objective: The clinical usefulness of the LENT score is unclear and we aimed to evaluate this at our district general hospital. Methods: We performed a retrospective analysis of patients who underwent pleural intervention for MPE at Royal Berkshire Hospital between May 2015 - September 2017. The LENT score was calculated retrospectively. Data was gathered for the number of patients undergoing talc pleurodesis and subsequent success rates, as well as the number underdoing IPC insertion and subsequent complication rates. Results: 40 patients were identified. Only 19 had a full data set to calculate the LENT score. Most patients had a primary diagnosis of lung cancer (30%), breast cancer (25%) or mesothelioma (18%). 26/40 patients underwent talc pleurodesis with 7 having further symptomatic fluid re-accumulation post talc (73% success rate). 25 patients had an IPC inserted, with the main complications being pleural infection (12%) and blocked catheter (8%). 5/19 (26%) patients were “high risk” as per LENT criteria. All “high risk” patients either died on the same admission or shortly post discharge. Conclusion: Using the LENT score will help risk-stratify patients with MPE to enable the most appropriate pleural intervention to be chosen from the outset, so as to alleviate breathlessness, whilst minimizing hospital stay and avoiding unnecessary procedure-related complications.